支气管动脉CTA对支气管动脉栓塞术的指导作用

目的探讨支气管动脉CTA对支气管动脉栓塞术(BAE)的指导作用。方法回顾性分析48例先后接受支气管动脉CTA及BAE的咯血病例,利用CTA MPR、VR及MIP技术准确、清晰记录支气管动脉分布情况、起源位置及方位、形态改变及非支气管动脉供血情况,并与BAE术中造影结果进行对比。结果 46例咯血患者(除外2例肺栓塞患者)CTA共检出102支支气管动脉,其中57支起源于T5~6椎体水平降主动脉,左侧支气管动脉供血6例,右侧支气管动脉供血9例,双侧支气管动脉共同供血31例;支气管动脉造影(BAG)检出的支气管动脉分布为左侧支气管动脉供血8例,右侧支气管动脉供血13例,双侧支气管动脉共同供血25例,两种方法检出的支气管动脉分布类型差异无统计学意义(P0.05)。CTA检出起源于降主动脉其他水平及其他体循环动脉(异常起源)45支,BAG检出2支。支气管动脉CTA检出20支支气管肋间动脉干,BAG检出4支。CTA检出11例非支气管动脉供血,BAG检出8例。在显示支气管肋间动脉干、非支气管动脉尤其是异常起源的支气管动脉方面,CTA优于BAG。结论支气管动脉CTA准确率高,可以为BAE提供详细的解剖信息,优化治疗方案,提高栓塞的准确率及效率,降低漏栓率。

Role of CTA prior to bronchial artery embolization

Objective To explore the role of CTA prior to bronchial artery embolization. Methods CTA was performed in 48 patients with hemoptysis who were referred for BAE. MPR, VR and MIP images were analyzed to identify the distribution, the origin and location of the course of bronchial arteries, and nonbronchial systemic arteries were also noted. These data were compared with bronchial artery angiography. Results CTA showed 102 bronchial arteries, 57 originated from the descending thoracic aorta at the level of T5-6 vertebral bodies. In 46 patients depicted by CTA, 6 patients showed the left bronchial arteries, 9 patients showed the right bronchial arteries, 31 patients showed both the left and right bronchial arteries. In bronchial artery angiography (BAG), 8 patients showed the left bronchial arteries, 13 patients showed the right bronchial arteries, 25 patients showed both the left and right bronchial arteries. There was no significant difference between CTA and BAG in the distribution of bronchial arteries (P>0.05). Forty-five ectopic bronchial arteries were depicted in CTA and only 2 in BAG. CTA showed 20 intercostobronchial arteries and BAG showed only 4. Eleven patients that showed nonbronchial systemic arteries in CTA were better than that showed in BAG among 8 patients. CTA was much better than BAG in showing the intercostobronchial arteries and nonbronchial systemic arteries, especially the ectopic bronchial arteries. Conclusion CTA is an accurate examination, it provide the anatomic informations and optimize treatment program. It can improve the accuracy and efficiency of bronchial artery embolization and decrease the omitting of arteries which were responsible for hemoptysis.